Many accountable care organizations have risen and fallen since the term was first popularized in healthcare, but the model itself remains prevalent in the industry. What are the ingredients for ACO success and how can these organizations sidestep the common pitfalls?
Chuck Lauer, an author, consultant, speaker and former publisher of Modern Healthcare, moderated a panel at the Becker's Hospital Review 6th Annual Meeting focused on ACO partnerships. The four panelists and Mr. Lauer shared their thoughts on the ideal ACO partners and the common partnership problems that arise.
The essential ACO partners
• Primary care providers. "Primary care providers are essential," said James M. Crawford, MD, PhD, professor and chair of the department of pathology and laboratory medicine at Hofstra North Shore-LIJ School of Medicine and executive director and senior vice president for laboratory services at North North-LIJ Health System. "I think all of us have to be striving to support the primary care provider."
• Payers. "The key thing is the payer partner," said Brian Silverstein, MD, managing partner of HC Wisdom. "If you are trying to manage a population you will get nowhere without data."
• Employers and civic agencies. "Employers in your region, civic agencies and your payers. Put that all together and it just might work," said Dr. Crawford.
• Consumers. "The consumer is our ultimate partner, no matter the delivery mechanism," said Dr. Crawford.
Partnership challenges
One of the largest obstacles to overcome when forming an ACO and aligning all of its partners is trust. "We as organizations have largely been competitors," said Joel Vengco, vice president and CIO of Baystate Health. "How can you make decisions democratically? Select leadership to keep the ball moving forward."
ACOs are still in their infancy. Much of the trust issue focuses on how entering into this kind of arrangement will affect reimbursement; there is no one set method. "Have the conversation about funds flow up front. Everyone needs to know how they will get paid and how reimbursement is affected," said Mary Bacaj, PhD, chief of staff and vice president of strategy, value-based care at Conifer Health Solutions. "The ACO governance body is scared to have that conversation, but do it up front and you can form trust early on."
Once enough trust has been garnered to actually form the ACO, operational challenges come into play. "The challenge of care coordination, risk stratification and data gathering: those are all things that hit you in the face when you try to build an ACO," said Dr. Crawford. Those are all issues that need to be addressed as an ACO begins to coalesce, all while keeping in mind how consumers will interact with the organization.